[Virtual Presenter] Welcome everyone! We are here today to discuss the important topic of FWA Compliance Training. We will discuss relevant laws that are designed to promote ethical practices in business and protect consumers. Let's get started.. 

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Fraud, Waste & abuse (fwa) Compliance training

[Audio] Fraud, waste and abuse are not tolerated in our company. Fraud involves deceiving, misrepresenting, or hiding information to achieve something valuable. Waste refers to excessively or inappropriately using services, misusing resources, or practices that cause unnecessary costs in federally-funded or state-funded programs. It is essential that we take the necessary steps to recognize and prevent such behavior. It is our responsibility to use our services and resources appropriately for our company and customers.. 

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Fraud An intentional act of deception, misrepresentation, or concealment in order to gain something of value Occurs when an individual knows or should know that something is false and makes a knowing deception that could result in some unauthorized benefit to him/herself or another person Waste Waste is defined as overutilizaton or inappropriate utilization of services, misuse of resources, or practices that result in unnecessary cost to a federally-funded or state-funded program

[Audio] Abuse can be related to Fraud, Waste and Abuse compliance as it entails situations when services or actions are used in an improper way that goes against accepted practice. This can result in payment for items or services, even though the intention is genuine, but at the end of the day, lead to an unnecessary cost incurred.. 

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Abuse Excessive or improper use of services or actions that is inconsistent with acceptable business or medical practice Refers to incidents that, although not fraudulent, may directly or indirectly cause financial loss Involves payment for items or services where there was no intent to deceive or mispresent, but the outcome results in unnecessary costs

[Audio] Fraud, Waste & Abuse Compliance Training is of utmost importance for Home of love, LLC. This training involves abstaining from offering, soliciting, or receiving a kickback, bribe, rebate, or falsifying claims and services. Additionally, kickbacks, fraudulent enrollment practices, and fraudulent recoupment practices are also covered in this type of training. Moreover, important issues around eligibility determination such as resource misrepresentation, residency, and household composition are included in this training. To summarise, all such actions are unethical and can lead to serious legal implications, hence it is essential to understand the relevant policies.. 

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Soliciting, offering, or receiving a kickback, bribe, or rebate Falsifying Claims/Encounters: Alteration of a claim; incorrect coding; double- billing; or false data submitted Falsifying Services: Billing for services/supplies not provided; misrepresentation of services/supplies; or substitution of services Administrative/Financial: Kickbacks; falsifying credentials; fraudulent enrollment practices; fraudulent Third Party Liability (TPL) reporting; or fraudulent recoupment practices Member Issues (Fraud) Eligibility Determination Issues: Resource misrepresentation (transfer/hiding); Residency; or household composition

[Audio] Compliance with the False Claims Act and the Anti-Kickback Statute is essential to run a successful business. The False Claims Act forbids knowingly submitting a false claim for reimbursement, making or utilizing an invalid document or declaration to back up a false claim, and participating in a conspiracy to do either of those activities. The Anti-Kickback Statute forbids offering, paying, requesting, or accepting anything of value to induce or remunerate allusions for items or services that can be refunded by a federal healthcare program. Anything of value, including cash or some other type of item, is considered remuneration.. 

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The False Claim Act (FCA) Prohibits knowingly presenting a false claim for payment or approval or making or using a false record or statement in support of a false claim Prohibits knowingly concealing or knowingly and improperly avoiding or decreasing an obligation to pay the Government Prohibits conspiring to violate the False Claims Act The Anti-Kickback Statute Makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of item or items or services reimbursable by a federal health care program Remuneration includes anything of value, directly or indirectly, overtly or covertly, in cash or in kind

[Audio] I will be discussing the Beneficiary Inducement Statute, the Self-Referral Prohibition Statute and the Red Flag Rule as part of the Fraud, Waste & Abuse Compliance Training. The Beneficiary Inducement Statute makes it illegal to provide certain incentives to Medicare beneficiaries, such as waiving coinsurance and deductible amounts if the beneficiary is in financial need. The Self-Referral Prohibition Statute, commonly known as the Stark Law, forbids physicians from referring Medicare patients to entities to which the physician or the physician's immediate family member is financially related. Lastly, the Red Flag Rule requires creditors to implement programs to detect and address any identity theft activities, patterns and practices.. 

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The Beneficiary Inducement Statute Prohibits certain inducements to Medicare beneficiaries –waiving the coinsurance and deductible amounts after determining in good faith that the individual is in financial need Self-Referral Prohibition Statute (Stark Law) Prohibits physicians from referring Medicare patients to an entity with which the physician or physician’s immediate family member has a financial relationship – unless an exception applies Red Flag Rule (Identity Theft Protection)  Requires “creditors” to implements programs to identify, detect, and respond to patterns, practices, or specific activities that indicate identity theft

[Audio] At Home of Love, LLC, we are committed to ensuring compliance with Fraud, Waste & Abuse (FWA) regulations. In particular, we are focusing on Arizona Revised Statute ARS 36-2918.01. This requires health care providers to report any suspected fraud or abuse perpetrated by members or providers. Those found to be purposely deceiving or misrepresenting with the aim of financial gain should be reported to AHCCCS. Moreover, AHCCCS has Prohibited Acts, which include presenting false, ineligible or misrepresented claims. We must ensure Home of Love is in compliance with all regulations, so let’s go over these topics and discuss how to make sure our practices are compliant.. 

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Arizona Revised Statute ARS 36-2918.01 Requires providers to immediately report suspected fraud and abuse Members or providers who intentionally deceive or misrepresent in order to obtain a financial gain or benefit they are not entitled to must reported to AHCCCS AHCCCS-Prohibited Acts Prohibits the presentation to AHCCCS or Program Contractor False Claims. Ineligible Claims Misrepresentation.

[Audio] The Federal Deficit Reduction Act of 2005 mandates organizations like Home of Love, LLC to produce written policies about federal and state false claims laws and whistleblower protections, as well as devise procedures to detect and prevent fraud, waste, and abuse. Compliance with this law is essential for the organization to stay abreast of the existing regulations.. 

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Federal Deficit Reduction Act of 2005 Requires any entity, including any Medicaid managed care organization such as Home of Love, LLC to establish written policies for its employees, subcontractors and agents that give detailed information about federal and state false claims laws and whistleblower protections and organization procedures and policies for detecting and preventing fraud, waste and abuse.

[Audio] Fraud, Waste & Abuse Compliance Training is of paramount importance for Home of Love, LLC. We want to make sure that our employees understand the severity of False Claim Acts and Anti-kickback Statute. According to the False Claim Act, if a false claim is detected, the provider is liable to pay a penalty of between $5000 to $10000. In case the government proves it suffered a loss due to this, the provider is responsible for three times the loss. On the other hand, Anti-kickback Statute is associated with up to five years in prison and fines of up to $25000. If a patient suffers bodily injury as a result of a scheme, the prison sentence may be higher than twenty years. Therefore, it is important that all employees are aware of the legal implications that come with committing any Fraud, Waste & Abuse.. 

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False Claim Act For each false claim: $5,000 - $10,000 If the government proves it suffered a loss, the provider is liable for three times the loss Anti-kickback Statute Up to five years in prison and fines of up to $25,000 If a patient suffers bodily injury as a result of a scheme, the prison sentence may be 20+ years

[Audio] Fraud, waste and abuse is a very serious infraction and can have severe consequences for anyone who commits it. First, it could result in termination of employment or contract. Civil money penalties and fines may also be imposed. In addition, a criminal conviction may lead to imprisonment, exclusion from federal health care programs and loss of provider license where applicable. That’s why it's so important to understand the regulations and follow the guidelines to remain compliant.. 

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The following are potential penalties for anyone who commits fraud, waste, or abuse and may vary depending on the violation:  Termination of employment or contract Civil Money Penalties Criminal Conviction/Fines Civil Prosecution Imprisonment Loss of Provider License, if applicable Exclusion from Federal Health Care programs

[Audio] The Whistleblower Protection Act, or WPA, seeks to protect federal employees who report violations of laws, rules, regulations, or abuses of authority that can jeopardize public safety or funds. Moving on, we will look at specific protective measures in place for whistleblowers.. 

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The Whistleblower Protection Act (WPA) is a federal law in the United States that aims to protect federal employees who report violations of laws, rules, regulations, gross mismanagement, waste of funds, abuse of authority, or a substantial danger to public health or safety within the federal government.

[Audio] Employees of Home of Love, LLC, should be aware of the protections provided by the Fraud, Waste & Abuse Compliance Training program. The Act ensures that they cannot be retaliated against if they report wrongdoing, fraud and abuse. The Office of Special Counsel has authority to investigate such complaints and provide remedies where necessary. It is important for employees to feel empowered to report any suspicious activity without fear of repercussions.. 

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Protect employee who disclose information they reasonably believe constitutes wrongdoing or illegal activities within the government from retaliation, such as demotion, termination, or harassment, as a result of their disclosure Encourages employees to report instances of wrongdoing, fraud and abuse, without fear of reprisal. This helps in promoting accountability, transparency, and integrity The Act provides procedures and channels for employees to report wrongdoing. It also outlines the process for investigating claims and taking corrective action in response to valid complaints. Empowers the Office of Special Counsel (OSC) to investigate and address complaints of retaliation against whistleblowers.  Employees who have faced retaliation can seek remedies, including reinstatement, back pay, or other corrective actions.

[Audio] You must understand your responsibility in preventing, detecting, and reporting any potential non-compliance and fraud, waste, and abuse as an employee of Home of Love, LLC. You must comply with all federal and state laws and regulations, company policies and procedures, and the company compliance program. You must report any violations to the laws, regulations, policies and procedures, and to the company’s compliance program. You must adhere to the company’s Code of Conduct, which outlines the commitment to act with integrity and other ethical rules of behavior.. 

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As an employee of Home of Love, LLC, you play a vital part in the prevention, detection, and in reporting any potential non-compliance and/or fraud, waste, and abuse. You are responsible in complying with all federal and state laws and regulations, company policies and procedures, and the company compliance program You are responsible for reporting any violations to the laws, regulations, policies and procedures, and to the company’s compliance program You have a duty to follow the company’s Code of Conduct, which articulates the commitment to act with integrity and outlines other ethical rules of behavior.

[Audio] It is essential that everyone is aware of the procedures and how they can go about reporting fraud, waste, and abuse. Absolutely anyone can report fraud, abuse or member abuse, and they may remain anonymous. To do so, one can call the toll free DES/DDD Hotline or fill out an online form available on the website. I trust this training has been useful and has provided everyone with the necessary information.. 

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Absolutely anyone can report fraud, abuse, or member abuse. There are no restrictions and you may remain anonymous To report suspected fraud, waste or abuse of the program, the provider performs one of the following:  Call the toll free DES/DDD Hotline at (888)-487-6686/(602) 417-4045/ (602) 417-4000 Report the incident by completing the on-line referral form.  https://azahcccs.gov/Fraud/ReportFraud/onlineform.aspx

[Audio] A whistleblower is someone who reveals any kind of wrongdoing or misconduct to an external party such as a regulator or government agency. It is possible to do this anonymously under the False Claims Act and, if successful, the whistleblower may receive a part of the resulting settlement. It must be remembered that employers are not allowed to threaten or take retaliatory action against whistleblowers.. 

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Whistleblower: An employee, former employee, or member of an organization who reports misconduct to people or entities that have the power to take corrective action. A provision in the False Claims Act allows individuals to: Report fraud anonymously Sue an organization on behalf of the government and collect a portion of any settlement that results Employers cannot threaten or retaliate against whistleblowers.

[Audio] We are committed to ensuring you are informed of laws, regulations, company policies, and that our compliance program is up-to-date. We will monitor claims and billing for accuracy and verify that documentation supports the services that have been provided. To ensure continued compliance, we will conduct regular internal audits and have open lines of communication with staff. Staff are expected to report any potential compliance issues immediately and may be asked about any compliance issues in exit interviews. We appreciate your attention and trust that this presentation was useful.. 

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Home of Love will ensure you are familiar and up to date with laws, regulations, company policies and procedures, and the company’s compliance program. Home of Love will monitor claims/billing for accuracy-ensure coding reflects services provided.  Staffs should documentation only supports services rendered. Home of Love, will perform regular internal audits. Home of Love shall establish effective lines of communication with staff members, verifying information provided to you. Ask about potential compliance issues in exit interviews. All staff shall lookout for suspicious activity and take action if you identify a problem and report it immediately

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Fraud, waste and abuse are not tolerated in our company. Fraud involves deceiving, misrepresenting, or hiding information to achieve something valuable. Waste refers to excessively or inappropriately using services, misusing resources, or practices that cause unnecessary costs in federally-funded or state-funded programs. It is essential that we take the necessary steps to recognize and prevent such behavior. It is our responsibility to use our services and resources appropriately for our company and customers.

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Abuse can be related to Fraud, Waste and Abuse compliance as it entails situations when services or actions are used in an improper way that goes against accepted practice. This can result in payment for items or services, even though the intention is genuine, but at the end of the day, lead to an unnecessary cost incurred.

Fraud, Waste & Abuse Compliance Training is of utmost importance for Home of love, LLC. This training involves abstaining from offering, soliciting, or receiving a kickback, bribe, rebate, or falsifying claims and services. Additionally, kickbacks, fraudulent enrollment practices, and fraudulent recoupment practices are also covered in this type of training. Moreover, important issues around eligibility determination such as resource misrepresentation, residency, and household composition are included in this training. To summarise, all such actions are unethical and can lead to serious legal implications, hence it is essential to understand the relevant policies.

Compliance with the False Claims Act and the Anti-Kickback Statute is essential to run a successful business. The False Claims Act forbids knowingly submitting a false claim for reimbursement, making or utilizing an invalid document or declaration to back up a false claim, and participating in a conspiracy to do either of those activities. The Anti-Kickback Statute forbids offering, paying, requesting, or accepting anything of value to induce or remunerate allusions for items or services that can be refunded by a federal healthcare program. Anything of value, including cash or some other type of item, is considered remuneration.

I will be discussing the Beneficiary Inducement Statute, the Self-Referral Prohibition Statute and the Red Flag Rule as part of the Fraud, Waste & Abuse Compliance Training. The Beneficiary Inducement Statute makes it illegal to provide certain incentives to Medicare beneficiaries, such as waiving coinsurance and deductible amounts if the beneficiary is in financial need. The Self-Referral Prohibition Statute, commonly known as the Stark Law, forbids physicians from referring Medicare patients to entities to which the physician or the physician's immediate family member is financially related. Lastly, the Red Flag Rule requires creditors to implement programs to detect and address any identity theft activities, patterns and practices.

At Home of Love, LLC, we are committed to ensuring compliance with Fraud, Waste & Abuse (FWA) regulations. In particular, we are focusing on Arizona Revised Statute ARS 36-2918.01. This requires health care providers to report any suspected fraud or abuse perpetrated by members or providers. Those found to be purposely deceiving or misrepresenting with the aim of financial gain should be reported to AHCCCS. Moreover, AHCCCS has Prohibited Acts, which include presenting false, ineligible or misrepresented claims. We must ensure Home of Love is in compliance with all regulations, so let’s go over these topics and discuss how to make sure our practices are compliant.

The Federal Deficit Reduction Act of 2005 mandates organizations like Home of Love, LLC to produce written policies about federal and state false claims laws and whistleblower protections, as well as devise procedures to detect and prevent fraud, waste, and abuse. Compliance with this law is essential for the organization to stay abreast of the existing regulations.

Fraud, Waste & Abuse Compliance Training is of paramount importance for Home of Love, LLC. We want to make sure that our employees understand the severity of False Claim Acts and Anti-kickback Statute. According to the False Claim Act, if a false claim is detected, the provider is liable to pay a penalty of between $5000 to $10000. In case the government proves it suffered a loss due to this, the provider is responsible for three times the loss. On the other hand, Anti-kickback Statute is associated with up to five years in prison and fines of up to $25000. If a patient suffers bodily injury as a result of a scheme, the prison sentence may be higher than twenty years. Therefore, it is important that all employees are aware of the legal implications that come with committing any Fraud, Waste & Abuse.

Fraud, waste and abuse is a very serious infraction and can have severe consequences for anyone who commits it. First, it could result in termination of employment or contract. Civil money penalties and fines may also be imposed. In addition, a criminal conviction may lead to imprisonment, exclusion from federal health care programs and loss of provider license where applicable. That’s why it's so important to understand the regulations and follow the guidelines to remain compliant.

The Whistleblower Protection Act, or WPA, seeks to protect federal employees who report violations of laws, rules, regulations, or abuses of authority that can jeopardize public safety or funds. Moving on, we will look at specific protective measures in place for whistleblowers.

Employees of Home of Love, LLC, should be aware of the protections provided by the Fraud, Waste & Abuse Compliance Training program. The Act ensures that they cannot be retaliated against if they report wrongdoing, fraud and abuse. The Office of Special Counsel has authority to investigate such complaints and provide remedies where necessary. It is important for employees to feel empowered to report any suspicious activity without fear of repercussions.

You must understand your responsibility in preventing, detecting, and reporting any potential non-compliance and fraud, waste, and abuse as an employee of Home of Love, LLC. You must comply with all federal and state laws and regulations, company policies and procedures, and the company compliance program. You must report any violations to the laws, regulations, policies and procedures, and to the company’s compliance program. You must adhere to the company’s Code of Conduct, which outlines the commitment to act with integrity and other ethical rules of behavior.

It is essential that everyone is aware of the procedures and how they can go about reporting fraud, waste, and abuse. Absolutely anyone can report fraud, abuse or member abuse, and they may remain anonymous. To do so, one can call the toll free DES/DDD Hotline or fill out an online form available on the website. I trust this training has been useful and has provided everyone with the necessary information.

 Absolutely anyone can report fraud, abuse, or member abuse. There are no restrictions and you may remain anonymous To report suspected fraud, waste or abuse of the program, the provider performs one of the following:  Call the toll free DES/DDD Hotline at (888)-487-6686/(602) 417-4045/ (602) 417-4000 Report the incident by completing the on-line referral form.  https://azahcccs.gov/Fraud/ReportFraud/onlineform.aspx


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A whistleblower is someone who reveals any kind of wrongdoing or misconduct to an external party such as a regulator or government agency. It is possible to do this anonymously under the False Claims Act and, if successful, the whistleblower may receive a part of the resulting settlement. It must be remembered that employers are not allowed to threaten or take retaliatory action against whistleblowers.

We are committed to ensuring you are informed of laws, regulations, company policies, and that our compliance program is up-to-date. We will monitor claims and billing for accuracy and verify that documentation supports the services that have been provided. To ensure continued compliance, we will conduct regular internal audits and have open lines of communication with staff. Staff are expected to report any potential compliance issues immediately and may be asked about any compliance issues in exit interviews. We appreciate your attention and trust that this presentation was useful.